Clival Defect with Primary CSF Rhinorrhea: A Very Rare Presentation with Challenging Management

Asad, Sheikh; Peters-Willke, Jens; Brennan, Warwick; Asad, Saima

doi:10.1016/j.wneu.2017.07.011

Cited by 13 publications

(18 citation statements)

References 15 publications

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“…The prevalence of S-CSF-L of all CSF fistulas in any location is between 3 and 40% in the series [4][5][6][7]. S-CSF-L is usually observed at the cribriform plate of the skull base.…”

Section: Discussionmentioning

confidence: 99%

“…Sphenoidal and, more specifically, clival localization is even less common [3]. S-CSF-L from the clivus is very rare, with few cases reported in the literature [6,7]. Meningitis is the most serious clinic complication in these cases.…”

Section: Discussionmentioning

confidence: 99%

“…CSF leakage due to primary defects and/or fracture of the clivus, or osteomyelitis of the clivus might lead to meningitis and recurrent meningitis [5][6][7][8][9][10][11][12][13]. Table 1 summarizes the published characteristics of meningitis cases that include clivus defects.…”

Section: Discussionmentioning

confidence: 99%

“…In the cases where clival defect was eventually found, the reasons outlined for the recurrences included a failure to give surgical consent following the first episode [5], ineffective first surgery [7], inappropriate antibiotherapy course for osteomyelitis [8], and misidentification of the exact leak site [9]. It is our understanding that the patient discussed herein was misdiagnosed following previous episodes.…”

Section: Discussionmentioning

confidence: 99%

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Clival defect in the pathogenesis of recurrent meningitis: a case report and literature review

et al. 2019

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Background: Meningitis is a life-threatening infection often associated with high morbidity. Recurrent bacterial meningitis poses a clinical challenge, both clinically and diagnostically. To prevent further recurrences, the underlying causes of recurrent bacterial meningitis should be investigated intensively. Case presentation: Here, we aim to present a patient referred to our clinic with rhinorrhea and found to the Staphylococcus aureus meningitis related to a clival defect. The patient reported no history of trauma, surgery, or brain neoplasm, and the cerebrospinal fluid leakage was classified as spontaneous. The patient had two episodes of meningitis in the last 4 years, but etiologic data of the previous episodes were absent. A pneumococcal vaccine was administered following her second attack, suggesting a possible Staphylococcus aureus infection due to altered colonization in the sinuses. She was successfully treated with linezolid but refused surgery to correct the defect and was discharged without neurologic sequelae. Conclusion: Spontaneous cerebrospinal fluid leakage from the clivus which could provoke recurrent meningitis is a rare situation. In conjunction with appropriate rapid antibiotherapy for the prevention of recurrent meningitis, the removal of anatomical risk factors should be a principal aim. Effective surgical procedures prevent recurrences.

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“…The prevalence of S-CSF-L of all CSF fistulas in any location is between 3 and 40% in the series [4][5][6][7]. S-CSF-L is usually observed at the cribriform plate of the skull base.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clival defect in the pathogenesis of recurrent meningitis: a case report and literature review

et al. 2019

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“…Table 1 presents a detailed description of all the PCF SL patients. Table 1 does not include (a) nonspontaneous (iatrogenic, after surgery or radiotherapy, post-traumatic) PCF liquorrhea; 7,8 (b) spontaneous PCF pneumocephalus due to bone defects that did not manifest in the form of SL; [9][10][11] (c) PCF bone defects or encephalocele (herniation) not accompanied by SL (or if this fact was not mentioned in the report); 12,13 (d) clivus defects manifesting in the form of SL, which, in turn, also can be attributed to PCF defects, but we believe that such pathology requires individual analysis; 14,15 (e) literature reviews without specifying own experience of PCF SL treatment; 16 and (f) reports where a PCF defect was mentioned for the general group of SL patients, but that had no required observation data (age, sex, symptoms, defect location, approach, complications, and so forth) 3,17,18…”

Section: Methodsmentioning

confidence: 99%

Spontaneous Cerebrospinal Fluid Leak of Posterior Surface of Temporal Bone: Review and Case Report

Sirko¹,

Berezniuk²,

Romanukha³

2017

An International Journal of Otorhinolaryngology Clinics

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Aim.To analyze the rarity of the clinical case report on spontaneous liquorrhea (SL) posterior cranial fossa (PCF) together with a review of the literature. To determine the features of PCF SL in contrast to anterior and middle cranial fossa (MCF) SL. To identify the optimal diagnostic and treatment tactics in patients with PCF SL. Materials and methods:We present clinical observations of a PCF SL patient and a detailed review of reports on SL with a defect on the posterior border of the petrous temporal bone (PTB). Results:Based on the literature review, 22 cases with a sufficient description were analyzed. PCF SL occurs more commonly in women than in men; middle-aged and elderly patients prevail. The average body mass index (BMI) was 33.3 ± 7, corresponding to a degree I obesity. The number of postoperative complications was quite large; each included recurrent liquorrhea. Conclusion:The data from our experience and a literature review for PCF SL patients are comparable with those of similar studies of SL in the anterior and MCF. Middle-aged and elderly women with excessive BMI are the most vulnerable. In most patients, the defect is located in the lateral regions of the posterior border of the PTB, namely anteriorly, medially from the sigmoid sinus, and below the upper petrosal sinus. A fairly high percentage of postoperative complications is due to insufficient preoperative diagnosis or intraoperative examination of the posterior PTB in patients with combined MCF and PCF defects, causing revision surgery.Clinical significance. If rhinorrhea, otorrhoea, and/or signs of intracranial space integrity loss (pneumocerephaly or latent liquorrhea with recurrent meningitis) are revealed, careful examination of bone structures of the anterior, middle, and also, be sure PCF is required, especially at the intersection with paranasal sinuses (frontal, ethmoidal, sphenoid) and mastoid air cells and PTB.

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CSF Rhinorrhea and Infection

2022

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Clival Defect with Primary CSF Rhinorrhea: A Very Rare Presentation with Challenging Management

Cited by 13 publications

References 15 publications

Clival defect in the pathogenesis of recurrent meningitis: a case report and literature review

Clival defect in the pathogenesis of recurrent meningitis: a case report and literature review

Spontaneous Cerebrospinal Fluid Leak of Posterior Surface of Temporal Bone: Review and Case Report

CSF Rhinorrhea and Infection

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